Diferencia entre revisiones de «Subclavian steal syndrome»
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==Background== | ==Background== | ||
* A stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. | * A stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. <ref> Potter BJ, Pinto DS. Subclavian steal syndrome. ''Circulation.'' 2014; 129(22):2320-3.</ref> | ||
* There is an increased incidence of left-sided subclavian stenosis | * There is an increased incidence of left-sided subclavian stenosis | ||
* The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms | * The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms | ||
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* [[Syncope]] | * [[Syncope]] | ||
==Differential Diagnosis== | ==Differential Diagnosis <ref> De Lorenzo R. Syncope. In: Marx J, ed. ''Rosen's Emergency Medicine.'' 8<sup>th</sup> ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141. </ref>== | ||
* Thoracic Outlet Syndrome | * Thoracic Outlet Syndrome | ||
* [[Verebrobasilar Insufficiency]] | * [[Verebrobasilar Insufficiency]] | ||
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* Ipsilateral radial pulse with decreased amplitude and delayed arrival | * Ipsilateral radial pulse with decreased amplitude and delayed arrival | ||
===Diagnostic Tests=== | ===Diagnostic Tests <ref> Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. ''NEJM.'' 1980; 302(24):1349-51</ref>=== | ||
* Routine testing for atherosclerosis: Lipid Panel, Glucose | * Routine testing for atherosclerosis: Lipid Panel, Glucose | ||
* Doppler Ultrasound | * Doppler Ultrasound | ||
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* If symptomatic, admit with consults to Vascular Surgery, Neurology | * If symptomatic, admit with consults to Vascular Surgery, Neurology | ||
* If incidental finding, consider close outpatient follow up | * If incidental finding, consider close outpatient follow up | ||
==References== | |||
<references/> | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Revisión del 21:14 16 ago 2016
Background
- A stenosis of the subclavian artery, proximal to the origin of the vertebral vessel, results in decreased perfusion pressure to the distal subclavian artery, leading to retrograde flow in the ipsilateral vertebral artery with exercise of the ipsilateral arm. In short, the arm steals blood flow from the vertebrobasilar system resulting in neurologic and upper extremity symptoms due to arterial insufficiency. [1]
- There is an increased incidence of left-sided subclavian stenosis
- The presence of collateral blood supply is the main determinant of which patients develop neurologic symptoms
Etiology
- Atherosclerosis
- Thoracic Outlet
- Congenital Anomalies
- Takayasu's Arteritis
Clinical Features
Symptoms in Upper Extremity
- Pain
- Fatigue
- Coolness
- Paresthesias
- Numbness
Neurologic Symptoms
Differential Diagnosis [2]
- Thoracic Outlet Syndrome
- Verebrobasilar Insufficiency
- Syncope
- Vertigo
Evaluation
Physical Exam Findings
- Supraclavicular bruit, thrill
- Systolic BP in ipsilateral brachial artery is reduced compared to opposite side
- Ipsilateral radial pulse with decreased amplitude and delayed arrival
Diagnostic Tests [3]
- Routine testing for atherosclerosis: Lipid Panel, Glucose
- Doppler Ultrasound
- Chest XRay, EKG
- CTA, MRA
- Angiography
Management
Medical management
- Treat atherosclerosis
- Antiplatelet Therapy
- Anticoagulant Therapy
Surgical management
Indicated for symptomatic patients
- Angioplasty with Endovascular Stenting
- CEA (in patients with associated carotid disease) by increasing collateral blood flow
- Surgical Bypass
Disposition
- If symptomatic, admit with consults to Vascular Surgery, Neurology
- If incidental finding, consider close outpatient follow up
References
- ↑ Potter BJ, Pinto DS. Subclavian steal syndrome. Circulation. 2014; 129(22):2320-3.
- ↑ De Lorenzo R. Syncope. In: Marx J, ed. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014: 135-141.
- ↑ Berguer R, Higgins R, Nelson R. Noninvasive diagnosis of reversal of vertebral-artery blood flow. NEJM. 1980; 302(24):1349-51